APTOS -- Medicare officials wonder why the per capita cost for long-term acute care services in Santa Cruz County is the lowest in the nation -- $17 vs. a national average of $80 -- so they sent a team to look for answers.

About 50 people gathered Thursday at Cabrillo College at the invitation of the Health Improvement Partnership of Santa Cruz County for an inquiry that is part of a yearlong innovation project funded by Medicare. Doctors, nurses and officials from hospitals, nursing homes and hospice participated.

Initially Medicare theorized the cost was low because Santa Cruz County does not have a long-term acute care hospital. The closest is in San Leandro.

But the agency found other regions without a specialized facility incurring higher costs than Santa Cruz.

Andrea Silvey, from Medicare's Health Services Advisory Group, pointed to Dr. Duncan Holbert, paralyzed by polio in 1949 and requiring an iron lung, yet practicing medicine in Santa Cruz as an allergy specialist, thanks to "the collaborative spirit of the community."

Participants, in small groups, shared stories about examples of good care and positive outcomes for a patient, then talked about their dreams for long-term acute care five years from now, with greater efficiency, higher quality and better outcomes.

Lois Widom, a member of Lifelong Learners, commended the Cabrillo College Stroke Center for improving the qualify of life for participants. Her dream, she said, is for older people not to be lonely.

Dr. Jeannine Rodems, president of the Santa Cruz County Medical Society, recalled an elderly patient who had her stuffed animal collection at the hospital and was visited by her friends in the arts community before she chose to go home with her daughter as caretaker and call for hospice services.

"Everything was the way she wanted it," Rodems said.

Sheri Anselmi of Elderday envisioned places where multi-generational families could live together and access concierge medical services.

MedLion, a primary care company founded by a doctor with a Watsonville location, is providing the kind of service she favors. Seniors 65 and up pay a fee of $39 a month; an office visit costs $10.

She also sees a need for a "navigator" for long-term care to help seniors access available resources. The role could be filled by a social worker, and be part of a health plan or a public program, she said.

After participants reported their findings, Monique Lambert, medical ethnographer and investigator for Palo Alto Medical Foundation saw a common theme.

"You say 'we can do this,'" she said. "You guys are kind of like activists... looking to go beyond the norms of practice. That's a significant thing."

She wondered if this can-do attitude can be replicated elsewhere.

Silvey said next steps involve creating a network, more data collection and deciding on one or two pilot projects starting as soon as April.